Gurfinkel EP

Idioma: Español
Referencias bibliográficas: 84
Paginas: 91-109
Archivo PDF: 138.28 Kb.

RESUMEN

En 1994, la United States Agency for Health Care Policy and Research dio a conocer las directrices para el diagnóstico y el tratamiento de la angina inestable y del infarto de miocardio no-Q. En los últimos 5 años, hubieron rápidos progresos con respecto al diagnóstico y al tratamiento de estas patologías. Por esto se están realizando esfuerzos para definir nuevas recomendaciones. En el International Forum of Cardiology, los investigadores discutieron los temas de diagnóstico y tratamiento que deberían ser modificados. Concluyeron que se debían recomendar los siguientes cambios: 1) el uso de marcadores séricos cardiacos debe incluir troponina I y/o T como métodos de diagnóstico y pronóstico, 2) la heparina de bajo peso molecular debería reemplazar a la heparina no fraccionada como agente antitrombótico, 3) nuevas clases de agentes antiplaquetarios son recomendados en adición a la aspirina, 4) el uso de drogas reductoras de la concentración de colesterol es adecuado en el tratamiento prolongado de estos pacientes. Estas revisiones y recomendaciones, incluyendo las evidencias aportadas por los estudios clínicos, se presentan en detalle en este trabajo.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Braunwald E: Unstable angina. A classification. Circulation 1989; 80:410-414.

2. Braunwald E, Brown J, Brown L, Cheitlin MD, Concannon CA, Cowan M, et al: Unstable Angina: Diagnosis and Management. Clinical Practice Guideline Number 10. Rockville, MD: U.S. Department of Health and Human Services, Agency for Health Care Policy and Research and the National Heart, Lung, and Blood Institute; 1994. AHCPR Publication No. 94-0602.

3. Braunwald E, Jones RH, Mark DB, Brown J, Brown L, Cheitlin MD, et al: Diagnosing and managing unstable angina. Agency for Health Care Policy and Research. Circulation 1994; 90: 613-622.

4. Campbell RW, Wallentin L, Verheugt FW, Turpie AG, Maseri A, Klein W, et al: Management strategies for a better outcome in unstable coronary artery disease. Clin Cardiol 1998; 21: 314-322.

5. Zaacks SM, Liebson PR, Calvin JE, Parrillo JE, Klein LW: Unstable angina and non-Q-wave myocardial infarction: does the clinical diagnosis have therapeutic implications? J Am Coll Cardiol 1999; 33:107-118.

6. Gurfinkel E: Current treatment and future prospects for the management of acute coronary syndromes. Clin Drug Invest 1998; 15:367-380.

7. Fuster V, Badimon L, Cohen M, Ambrose JA, Badimon JJ, Chesebro J: Insights into the pathogenesis of acute ischemic syndromes. Circulation 1988; 77:1213-1220.

8. Bugiardini R, Conti CR: Unstable angina: prognosis of the individual patient. Clin Cardiol 1998; 21:706-710,

9. Jaffe AS: Troponin, where do we go from here? Clin Lab Med 1997; 17:737-752.

10. Antman EM, Tanasijevic MJ, Thompson B, Schactman M, McCabe CH, Cannon CP, et al: Cardiac specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med 1996; 335:1342-1349.

11. Ohman EM, Armstrong PW, Christenson RH, Granger CB, Katus HA, Hamm CW, et al: Cardiac troponin T levels for risk stratification in acute myocardial ischemia. N Engl J Med 1996; 335:1333-1341.

12. Hamm CW, Goldmann BU, Heeschen C, Kreymann G, Berger J, Meinertz T: Emergency room triage of patients with acute chest pain by means of rapid testing for cardiac troponin T or troponin I. N Engl J Med 1997; 337:1648-1653.

13. Stubbs P, Collinson P, Moseley D, Greenwood T, Noble M: Prospective, study of the role of cardiac troponin T in patients admitted with unstable angina. BMJ 1996: 313:262-264.

14. Davie EW, Fujikawa K, Kisiel W: The coagulation cascade: initiation, maintenance, and regulation. Biochemistry 1991; 30:10363-10370.

15. Hirsh J, Fuster V: Guide to anticoagulant therapy. Part 1: Heparin. Circulation 1994; 89:1449-1468.

16. Theroux P, Ouimet H, McCans J, Latour JG, Joly P, Levy G, et al: Aspirin, heparin or both to treat acute unstable angina. N Engl J Med 1988; 319:1105-1111.

17. Théroux P, Wateers D, Qiu S, McCans J, de Guise P, Juneau M: Aspirin versus heparin to prevent myocardial infarction during the acute phase of unstable angina. Circulation 1993; 88:2045-2048.

18. Lane DA, Pejler G, Flynn AM, Thompson EA, Lindahi U: Neutralization of heparin-related saccharides by histidine-rich glycoprotein and platelet factor 4. J Biol Chem 1986; 261: 3980-3986.

19. Barradas MA, Mikhailidis DP, Epemolu O, Jeremy JY, Fonseca V, Dandona P: Comparison of the platelet pro-aggregatory effect of conventional unfractionated heparin and a low molecular weight heparin fraction (CY 222). Br J Haematol 1987; 67: 451-457.

20. Hirsh J, Levine MN: Low molecular weight heparin. Blood 1992; 79:1-17.

21. Lefkovits J, Topol EJ: Direct thrombin inhibitors in cardiovascular medicine. Circulation 1994; 90:1522-1536.

22. Collignon F, Frydman A, Caplain H, Ozoux ML, Le Roux Y, Bouthier J, Thebault JJ: Comparison of the pharmacokinetic profiles of three low molecular mass heparins-dalteparin, enoxaparin and nadroparin-administered subcutaneously in healthy volunteers (doses for prevention of thromboembolism). Thromb Haemost 1995; 73:630-640.

23. Howard PA: Dalteparin: a low-molecular-weight heparin. Ann Pharmacother 1997; 31:192-203.

24. Buckley MM, Sorkin EM: Enoxaparin. A review of its pharmacology and clinical applications in the prevention and treatment of thromboembolic disorders. Drugs 1992; 44: 465-497.

25. Davis R, Faulds D: Nadroparin calcium. A review of its pharmacology and clinical use in the prevention and treatment of thromboembolic disorders. Drugs Aging 1997; 10: 299-322.

26. Klein W, Buchwald A, Hillis SE, Monrad S, Sanz G, Turpie AG, et al: Comparison of low-molecular-weight heparin with unfractionated heparin acutely and with placebo for 6 weeks in the management of unstable coronary artery disease. Circulation 1997; 96:61-68.

27. Gurfinkel EP, Manos EJ, Mejail RI, Cerda MA, Duronto EA, Garcia CN, et al: Low molecular weight heparin versus regular heparin or aspirin in the treatment of unstable angina and silent ischemia. J Am Coll Cardiol 1995; 26:313-318.

28. Comparison of two treatment durations (6 days and 14 days) of a low molecular weight heparin with 2-6 ay treatment of unfractismatel heparin in the initial management of unstable angina or non-O wave myocardial infarction: FRAXA.1.S (FRAXiparine in Ichemic Syndrome). Eur Heart J 1999; 20:1553-1562.

29. Cohen M, Demers C, Gurfinkel EP, Turpie AG, Fromell GJ, Goodman S, et al: A comparison of low-molecular-weight heparin with unfractionated heparin for unstable coronary artery disease. N Engl J Med 1997; 337:447-452.

30. Goodman S, Bigonzi F, Radley D, Le louer V, Gosset F, Cohen M: One-year follow-up of the ESSENCE trial (enoxaparin versus heparin in unstable angina and non-Q-wave myocardial infarction) (Abstr). Eur Heart J 1998; 19 (abstr suppl):P477.

31. Antman EM: TIMI IIB. Enoxaparin versus unfractionated heparin for unstable angina or non-Q-wave myocardial infarction: a double-blind, placebo-controlled, parallel-group, multicenter trial. Rationale, study design, and methods. Am Heart J 1998; 135:S353-S360.

32. Antman EM, McCabe CH, Gurfinkel EP, Turpie AG, Bernink PJ, Salein D, et al: Enoxaparin prevents death and cardiac ischemic events in unstable angina/non-Q-wave myocardial infarction: results of the Thrombolysis in Myocardial Infarction (TIMI) IIB trial. Circulation 1999; 100:1593-1601.

33. Pineo GF, Hull RD: Hirudin and hirudin analogues as new anticoagulant agents. Curr Opin Hematol 1995; 2:380-385.

34. OASIS-2 Investigators: Effects of recombinant hirudin (lepirudin) compared with heparin on death, myocardial infarction, refractory angina, and revascularization procedures in patients with acute myocardial ischaemia without ST elevation: a randomized trial. Lancet 1999; 353:429-438.

35. Warkentin TE: Heparin-induced thrombocytopenia. Pathogenesis, frequency, avoidance and management. Drug Saf 1997; 17:325-341.

36. Schiele F, Vuillemenot A, Kramarz P, Kieffer Y, Anguenot T, Bernard Y, Bassand JP: Use of recombinant hirudin as antithrombotic treatment in patients with heparin-induced thrombocytopenia. Am J Hematol 1995; 50:20-25.

37. Greinacher A, Volpel H, Janssens U, Hach-Wunderle V, Kemkes-Matthes B, Eichler P, et al: Recombinant hirudin (lepirudin) provides safe and effective anticoagulation in patients with heparin-induced thrombocytopenia: a prospective study. Circulation 1999; 99:73-80.

38. Becker RC: Seminars in thrombosis, thrombolysis and vascular biology 3. Platelet activity in cardiovascular disease. Cardiology 1991; 79:49-63.

39. Antiplatelet Trialists’ Collaboration: Collaborative overview of randomized trials of antiplatelet therapy. I. Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ 1994; 308:81-106.

40. Pappas JM, Westengard JC, Bull BS: Population variability in the effect of aspirin on platelet function. Implications for clinical trials and therapy. Arch Pathol Lab Med 1994; 118:801-804.

41. Buchanan MR, Brister SJ: Individual variation in the effects of ASA on platelet function: Implications for the use of ASA clinically. Can J Cardiol 1995; 11: 221-227.

42. Haynes RB, Sandler RS, Larson EB, Pater JL, Yatsu FM: A critical appraisal of ticlopidine, a new antiplatelet agent. Effectiveness and clinical indications for prophylaxis of atherosclerotic events. Arch Intern Med 1992; 152:1376-1380.

43. Schomig A, Neumann FJ, Kastrati A, Schuhlen H, Blasini R, Hadamitzky M, et al: A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents. N Engl J Med 1996; 334:1084-1089.

44. Leon MB, Baim DS, Popma JJ, Gordon PC, Cutlip DE, Ho KK, et al: A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting. N Engl J Med 1998; 339:1665-1671.

45. Love BB, Biller J, Gent M: Adverse haematological effects of ticlopidine. Prevention, recognition and management. Drug Saf 1998; 19: 89-98.

46. Coukell AJ, Markham A: Clopidogrel. Drugs 1997; 54:745-750.

47. CAPRIE Steering Committee. A randomized, blinded trial of clopidogrel versus aspirin in patients at high risk of ischemic events. (CAPRIE). Lancet 1996; 348:1329-1339.

48. Madan M, Berkowitz SD, Tcheng JE: Glycoprotein IIb/IIIa integrin blockade. Circulation 1998; 98:2629-2635.

49. The EPIC Investigators: Use of a monoclonal antibody directed against the platelet glycoprotein IIB/IIIa receptor in high-risk coronary angioplasty. N Engl J Med 1994; 330:956-961.

50. Topol EJ, Califf RM, Weisman HF, Ellis SG, Tcheng JE, Worley S, et al: Randomized trial of coronary intervention with antibody against platelet IIb/IIIa integrin for reduction of clinical restenosis: Results at six months. Lancet 1994; 343:881-886.

51. Topol EJ, Ferguson JJ, Weisman HF, Tcheng JE, Ellis SG, Kleiman NS, et al: Long-term protection from myocardial ischemic events in a randomized trial of brief integrin beta 3 blockade with percutaneous coronary intervention. JAMA 1997; 278:479-484.

52. The EPILOG Investigators: Platelet glycoprotein IIB/IIIa receptor blockade and low-dose heparin during percutaneous coronary revascularization. New Engl J Med 1997; 336: 1689-1696.

53. The CAPTURE Investigators: Randomized placebo-controlled trial of abciximab before and during coronary intervention in refractory unstable angina: the CAPTURE study. Lancet 1997; 349:1429-1435.

54. The PURSUIT Trial Investigators: Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute coronary syndromes. N Engl J Med 1998; 339:436-443.

55. The PRISM-PLUS Study Investigators: Inhibition of the platelet glycoprotein IIb/IIIa receptor with tirofiban in unstable angina and non-Q-wave myocardial infarction. N Engl J Med 1998; 338:1488-1497.

56. Peterson JG, Lauer MA, Sapp SK, Topol EJ: Heparin use is required for clinical benefit of GIIb/IIIa inhibitor eptifibatide in acute coronary syndromes: insights from the PURSUIT trial (Abstr). Circulation 1998; 98 (suppl I):I-360.

57. The PARAGON Investigators: International, randomized, controlled trial of lamifiban (a platelet glycoprotein IIb/IIIa inhibitor), heparin, or both in unstable angina. Circulation 1998; 97:2386-2395.

58. The IMPACT II Investigators: Randomized placebo-controlled trial of effect of eptifibatide on complications of percutaneous coronary intervention: IMPACT II. Lancet 1997; 349: 1422-1428.

59. The RESTORE Investigators: Effects of platelet glycoprotein IIb/IIIa blockade with tirofiban on adverse cardiac events in patients with unstable angina or acute myocardial infarction undergoing coronary angioplasty. Circulation 1997; 96: 1445-1453.

60. Hansson L, Zanchetti A, Carruthers SG, Dahlof B, Elmfeldt D, Julius S, et al: Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomized trial. HOT Study Group. Lancet 1998; 351:1755-1762.

61. Rackley CE: Monotherapy with HMG-CoA reductase inhibitors and secondary prevention in coronary artery disease. Clin Cardiol 1996; 19:683-689.

62. The Scandinavian Simvastatin Survival Study Group: Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344:1383-1389.

63. 63.The LIPID Study Group: Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339:1349-1357.

64. Byington RP, Jukema JW, Salonen JT, Pitt B, Bruschike AV, Hoen H, et al: Reduction in cardiovascular events during pravastatin therapy. Pooled analysis of clinical events of the pravastatin atherosclerosis intervention program. Circulation 1995; 92:2419-2425.

65. Shepherd J, Cobbe SM, Ford I, Isles CG, Lorimer AR, MacFarlane PW, et al: Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. New Engl J Med 1995; 333:1301-1307.

66. Schwartz GG, Oliver MF, Ezekowitz MD, Ganz P, Waters D, Kane JP, et al: Rationale and design of the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study that evaluates torvastatin in unstable angina pectoris and in non-Q-wave acute myocardial infarction. Am J Cardiol 1998; 81:578-581.

67. Downs JR, Clearfield M, Weis S, Whitney E, Shapiro DR, Beere PA, et al: Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. JAMA 1998; 279:1615-1622.

68. Grundy Sm: Statin trials and goals of cholesterol-lowering therapy. Circulation 1998; 97:1436-1439.

69. Sacks FM, Peffer MA, Moye LA, Rouleau JL, Rutherford JD, Cole TG, et al: The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med 1996; 335:1001-1009.

70. Wood D, De Backer G, Faergeman O, Graham I, Mancia G, Pyorala K et al: Prevention of coronary heart disease in clinical practice. Recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention. Eur Heart J 1998; 19:1434-1503.

71. National Cholesterol Education Program: Cholesterol lowering in the patient with coronary heart disease. Washington, D.C.: U.S. Departament of Health and Human Services, Public Health Service, National Istitutes of Health, National Heart, Lung and Blood Institute; 1997. NIH Publication No. 97-3794.

72. Grundy SM, Balady GJ, Criqui MH, Fletcher G, Greenland P, Hiratzka LF, et al: When to start cholesterol-lowering therapy in patients with coronary disease: a statement for healthcare professionals from the American Heart Association Task Force on Risk Reduction. Circulation 1997; 95:1683-1685.

73. The TIMI IIIB Investigators: Effects of tissue plasminogen activator and a comparison of early invasive and conservative strategies in unstable angina and non-Q-wave myocardial infarction: Results of the TIMI IIIB Trial. Circulation 1994; 89:1545-1556.

74. Boden WE, O’Rourke RA, Crawford MH, Blaustein AS, Deedwania PC, Zoble RG, et al: Outcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compared with a conservative management strategy. N Engl J Med 1998; 338:1785-1792.

75. Yusuf S, Flather M, Pogue J, Hunt D, Varigos J, Piegas L, et al. Variations between countries in invasive cardiac procedures and outcomes in patients with suspected unstable angina or myocardial infarction without initial ST elevation. OASIS (Organization to Assess Strategies for Ischaemic Syndromes) Registry Investigators. Lancet 1998; 352:507-514.

76. Krumholz HM, Philbin DM Jr, Wang Y, Vaccarino V, Murillo JE, Therrien ML, et al: Trends in the quality of care for Medicare beneficiaries admitted to the hospital with unstable angina. J Am Coll Cardiol 1998; 31:957-963.

77. Kizer JR, Cannon CP, McCabe CH, Mueller HS, Schweiger MJ, Davis VG, et al: Trends in the use of pharmacotherapies for acute myocardial infarction among physicians who design and/or implement randomized trials versus physicians in routine clinical practice: the MILIS-TIMI experience. Am Heart J 1999; 137:79-92.

78. Simpson RJ Jr, Weiser RR, Naylor S, Sueta CA, Metts AK: Improving care for unstable angina patients in a multiple hospital project sponsored by a federally designated quality improvement organization. Am J Cardiol 1997; 80:80H-84H.

79. Reis SE, Holubkov R, Zell KA, Edmundowicz D, Shapiro AH, Feldman AM: Unstable angina: specialty-related disparities in implementation of practice guidelines. Clin Cardiol 1998; 21:207-210.

80. McLaughlin TJ, Soumerai SB, Willison DJ, Gurwitz JH, Borbas C, Guadagnoli E, et al: Adherence to national guidelines for drug treatment of suspected acute myocardial infarction: evidence for undertreatment in women and the elderly. Arch Intern Med 1996; 156: 799-805.

81. Alexander KP, Peterson ED, Granger CB, Casas AC, Van de Werf F, Armstrong PW, et al: Potential impact of evidence-based medicine in acute coronary syndromes: insights from GUSTO-IIb. J Am Coll Cardiol 1998; 32:2023-2030.

82. Campeau L: Grading of angina pectoris [letter]. Circulation 1976; 54:522-523.

83. The GUSTO IIb Investigators: A comparison of recombinant hirudin with heparin for the treatment of acute coronary syndromes. N Engl J Med 1996; 335:775-782.

84. Antman EM, Braunwald E: Acute myocardial infarction. En Brunwald E, ed. “Heart disease: a textbook of cardiovascular medicine, Vol 2”. Philadelphia. WB Saunders Company, 1995; 1184-1288.